Primary and secondary care management of women with early breast cancer from affluent and deprived areas: retrospective review of hospital and general practice records
Open accessAbstract
OBJECTIVES: To investigate whether poorer survival of breast cancer among deprived women compared with affluent women is related to their NHS care. DESIGN: Retrospective review of hospital and general practice case records. SETTING: Greater Glasgow Health Board area. SUBJECTS: Women diagnosed with breast cancer in 1992-3 who lived in the most affluent (deprivation categories 1 and 2) and the most deprived areas (deprivation categories 6 and 7) of Glasgow (Carstairs and Morris deprivation index). MAIN OUTCOME MEASURES: Breast cancer treatment, time from general practice consultation to clinic visit and surgery, and details of hospital admissions and follow up in primary and secondary care. RESULTS: The access to care and surgical and oncological treatment of women from affluent and deprived areas were similar. Admissions to hospital for problems not related to breast cancer were more common in those living in deprived areas (number admitted once or more: 51 (24%) v 13 (10%), P=0.001). Consultation patterns in general practice by the second year after diagnosis showed women in deprived areas consulting more frequently than women in affluent areas (median (interquartile range) number of consultations (5 (2-10) v 7 (4-13), P=0.01). CONCLUSION: Women living in affluent areas did not receive better NHS care for breast cancer than women in deprived areas. However, women from deprived areas seem to have greater comorbidity, and poorer outcomes from breast cancer among these women is probably due to factors which result in deprived communities having poorer health outcomes rather than to management of their breast cancer.
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Services that are less permeable tend to have high levels of default by socio-economically disadvantaged people.
“Services that are less permeable tend to have high levels of default by socio-economically disadvantaged people [50-53].”
From Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups (2006) · cites this paper as [52]
The Follow up section reports that women from deprived areas were more likely to miss breast-cancer clinic appointments (12% versus 4%) and suggests that ease of access to hospital may be a factor. It does not assess whether the service was ‘less permeable’ or establish a general tendency across services. (LLM, conf=0.87)
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Self-citation
- Authors
- Macleod, U.
- Affiliations
- University of Glasgow (GB)
- Corresponding author
- Macleod, U.
- ORCID
- Macleod, U.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2000-05-27
- Volume
- 320
- Issue
- 7247
- Pages
- 1442-1445
- ISSN
- 0959-8138 (ISSN-L)
- PMC
- PMC27387
- OpenAlex
- W2049868820
- Cited by
- 64
- References
- 22
- Citations by year
- 2024: 1 · 2017: 1 · 2016: 2 · 2015: 4 · 2014: 4 · 2013: 1 · 2012: 5
- FWCI
- 2.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Social Sciences › Health › Health disparities and outcomes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Keywords
- breast cancer, socioeconomic deprivation, health disparities, health care access, primary care, secondary care, hospitalization, general practitioner visits, Glasgow, comorbidities
- MeSH terms
- Adult, Aged, Breast Neoplasms, Family Practice, Female, Follow-Up Studies, Health Services Accessibility, Hospitalization, Humans, Middle Aged, Poverty, Retrospective Studies, Scotland, State Medicine
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